Our SLP chat tonight, Monday, February 10, 2003, is being hosted by
Lisa Scott Trautman, Ph.D., CCC-SLP, who will address the topic of
counseling and speech-language pathology.  Dr. Trautman is an assistant
professor in the Department of Communicative Disorders and Sciences at
Florida State University where she teaches courses in stuttering and
counseling.  In addition to her position at FSU, she works as a
professional consultant to theStuttering Foundation of America, planning
continuing education and new publications in the area of stuttering.
A CertifiedFluency Specialist, she has evaluated, treated, and/or
consulted with over 150 school-age children who stutter, and many adults
and preschool children as well.  In addition to her clinical work,
she has made presentations at district, state, and national meetings,
and co-authored several publications in the area of fluency disorders.

<Robin> Hello everyone!  Thanks for being here tonight!
<Robin>   We are chatting tonight with Lisa Scott Trautman, Ph.D., CCC-SLP, about counseling.
<Lisa_Scott_Trautman> Hi everyone
<Robin> Dr. Trautman, could you give us some background on counseling and speech pathology?
<Lisa_Scott_Trautman> Sure
<Robin> How they go together and what the SLP should know?
<Lisa_Scott_Trautman> Counseling has always gone hand in hand with our field, but probably
          the first person to really do any writing on the topic was David Luterman, who's an
<Lisa_Scott_Trautman> But, many people like Van Riper, Sheehan, Johnson, and others have
          incorporated counseling.
<Lisa_Scott_Trautman> As far as how counseling and slp goes together, I think one of the
          most important aspects is that creating a good relationship with our clients is
          first and foremost in treatment.
<Lisa_Scott_Trautman> And to create a good relationship with clients, we have to have good
          relationship skills: listening, being able to validate what the client is feeling,
          knowing how to interview well -- these are all basic counseling skills.
<Robin> How many SLP programs currently address this issue as part of the program's
<Lisa_Scott_Trautman> Fewer than 10% of the programs in the nation REQUIRE a course in
<Lisa_Scott_Trautman> Others offer it (I would estimate about half) but it's not a
<Lisa_Scott_Trautman> Many classes, like diagnostics, voice disorders, stuttering, will
          incorporate counseling skills into the course, though.
<angiefsu> You mentioned the audiologist, but are there others that focus solely on
          counseling (in research and practice)...  Can a PhD focus on that area?
<Lisa_Scott_Trautman> Yes you could focus on counseling in a PhD program in speech path,
          but you might be restricted in where you would go to do that.
<Lisa_Scott_Trautman> The other option would be to do a PhD in another program besides
          speech path.
<angiefsu> I've thought about that actually.
<Lisa_Scott_Trautman> Other people in the country who are very interested in counseling in
          the field include Tom Crowe at U of Miss, Walt Manning at Memphis.
<Christine> Do you think that the reason so few programs delve in to it is because it is
          hard to get reimburstment?
<Lisa_Scott_Trautman> I think the reason few programs delve in is because of the
          reimbursement issue, plus I think there are lots of people who feel uncomfortable
          with counseling and think that it's outside our scope of practice.
<Lisa_Scott_Trautman> But if you look at the ASHA Preferred Practice patterns, counseling
          is specifically mentioned.
<Christine> I've seen it in the school-based policy manual.
<Robin> What are some of the most important skills for us to utilize in regard to counseling?
<Lisa_Scott_Trautman> The most basic skill is learning to listen.
<angiefsu> I heard a wonderful quote... the reason you are given two ears and one mouth is
          so you can listen twice as much as you speak.
<Lisa_Scott_Trautman> I was fortunate enough to attend a workshop this past summer with
          Dr. Luterman, and we spent 5 days learning to listen.
<Robin> What are the most important  skills we should be using?
<Lisa_Scott_Trautman> One is listening
<Lisa_Scott_Trautman> I tend to want to jump in too fast when others are talking.
<Lisa_Scott_Trautman> And as they're talking, I'm thinking of what my response to them will
          be -- how I'm going to give them info or tell them something about how they're
          feeling, when instead, I should just be quiet and really listen to what they're saying.
<Christine> I tend to finish others' sentences when they have some word finding difficulties.
<Lisa_Scott_Trautman> I think we all finish sentences, it's natural for SLPs!
<Christine> I find jotting my thoughts down and points they are mentioning, helps me not
<Lisa_Scott_Trautman> One of the ways I learned to work on my listening and not having to
          respond immediately was to count in my head, 1-2-3-4-5 after a client finished
          speaking and before I said anything.
<Lisa_Scott_Trautman> And I also try to rephrase what the client has said, "Just now, you
<Lisa_Scott_Trautman> That helps me make sure I've really listened and heard what he or
          she said.
<Lisa_Scott_Trautman> And it also helps them know I'm paying attention!
<Lisa_Scott_Trautman> But, scaffolding a client who's having difficulty communicating is
          different from talking and not really listening.
<Robin> Can you define scaffolding?
<Lisa_Scott_Trautman> Sorry, yes, scaffolding is providing assistance to the client so
          they can express themselves.
<AdrienneFSU> Speaking of scaffolding, how can you maintain a focus or purpose in
          counseling to avoid tangents, but still listen to what the client says?
<Lisa_Scott_Trautman> Adrienne, I think the way I would try to look past the tangents is
          to focus on the emotions the client is trying to communicate.
Lisa_Scott_Trautman> Also, sometimes you will want to say, "let me make sure I have this
          right..." and then summarize. Sometimes scaffolding does not mean that we are
          expanding language for the client.
<Lisa_Scott_Trautman> It can also mean structuring topics for them.
<Lisa_Scott_Trautman> For example, giving a client a cloze cue or binary choice, or asking
          them to summarize a conversation.
<Christine> Would that include giving some multiple choice items to help one clarify their
<Lisa_Scott_Trautman> Yes, giving multiple choice is also a form of scaffolding.
<Lisa_Scott_Trautman> Another important lesson I've learned when someone is telling you
          something important, try to respond to the feeling rather than to the statement.
<Christine> Let me ask you about how you respond by identifying the emotions.
<Lisa_Scott_Trautman> If you respond to the feeling of what someone is communicating rather
          than the message, it will help clients to feel "visible".
<Lisa_Scott_Trautman> For example, if a mom says, "This week we didn't get any homework
          done; it was just so busy we didn't have time."
<Lisa_Scott_Trautman> You might respond by saying, "It sounds like you're feeling really
          stressed out."
<Lisa_Scott_Trautman> If you offer the wrong emotion, clients will correct you immediately.
<Lisa_Scott_Trautman> But if it's the right one, usually they'll keep on talking and tell
          you more, and usually what they expand with is what you really want/need to know.
<Christine> What do you think about using the person's sensory words- think, feel, I see
          what you mean, etc.?
<Lisa_Scott_Trautman> Mm hm, I think using sensory words is important.
<Lisa_Scott_Trautman> and also probing, "when you said you think you're bad at XX, I'm
          wondering what you mean by "bad" at it?"
<Christine> We use that in coaching too, I love it!
<Lisa_Scott_Trautman> Counseling is a lot like coaching, actually. You are coaching
          clients/families in how to respond in a healthier way.
<Lisa_Scott_Trautman> Which is different from psychotherapy, and this is where I
          think there's a lot of confusion in our field.
<Lisa_Scott_Trautman> Psychotherapy is about helping the person adjust their personality
          to be healthier etc.
<Lisa_Scott_Trautman> Counseling is more about changing behaviors and thought processes
          to respond in a healthier way to their situation.
<Lisa_Scott_Trautman> You're not trying to change the person.
<angiefsu> In my limited experience, I've found that changing my mindset from thinking of
          the person as a "client" to thinking of them as a person/friend has helped me.
<Christine> In my organization, Family Support Network -we call ourselves service providers.
<Lisa_Geng> What about counseling when talking to a child who is struggling to talk?
          Do you do the same?
<Lisa_Scott_Trautman> Yes, if a child is having difficulty talking, letting them know you
          hear what they are feeling is important.
<Lisa_Scott_Trautman> Because that's the reason most of us communicate in the first place.
<Lisa_Scott_Trautman> Angie, shifting how you see clients is a very important part of the
<Christine> (Human Communication Theory)
<Lisa_Scott_Trautman> Right Christine
<Lisa_Scott_Trautman> I always try to think of how I can show my client or my student or
          my client's family unconditional positive regard -- I think you're important no
          matter what.
<Lisa_Scott_Trautman> When you start looking at interactions as being about the client
          rather than about you, or what you do or don't know how to do, it frees you up a lot.
<Lisa_Scott_Trautman> If that makes sense
<Lisa_Scott_Trautman> So, listening is important.
<Lisa_Scott_Trautman> Being able to respond to feelings is important.
<Lisa_Scott_Trautman> Another think I've worked on inhibiting is my need to give information.
<Lisa_Scott_Trautman> Christine, my specialty area is stuttering and one of the things that
          can be really scary to do is tell parents that their young child is stuttering.
<hallie> I am just starting with my first two fluency clients.
<Lisa_Scott_Trautman> And when a parent, or client for that matter, is really distressed,
          my first response is usually to want to tell them everything I know about stuttering.
<Lisa_Scott_Trautman> As if me telling them all sorts of info about stuttering is going to
          make them feel less bad or something.
<Lisa_Scott_Trautman> But really that's about me feeling inadequate in the situation so I
          resort to something I know I'm good at -- sharing information. Which probably is
          not what the client needs at that moment.
<Lisa_Geng> With an upset child -Is it OK to once in awhile then pretend you understand
          something being said that you don't (from the child) ?
<Lisa_Scott_Trautman> Yes I think it's ok to pretend to understand as long as you're
          prepared for the consequences if there's a mix-up!
<Christine> I'd also like to chime in and say it depends on the age of the client.
<Lisa_Scott_Trautman> I agree Christine.
<Christine> Many clients can hear the difference in your voice if you feign understanding.
<Christine> What do you think the client needs?
<Lisa_Scott_Trautman> Well, when a client or family member is really distressed, usually
          what they need most is for someone to say, this is hard.
<Robin> What are your suggestions for dealing with a client or family member who is in
          denial ?
<Lisa_Scott_Trautman> Robin, your question about denial... that's a very tough one
<Lisa_Scott_Trautman> Denial is an unhealthy coping strategy, but sometimes it's the best
          one the client/family member has at the time.
<Lisa_Scott_Trautman> So, first my goal is to move them in a healthier direction.
<Lisa_Scott_Trautman> I might start that process by trying to identify what "evidence" I
          can gently provide on a regular basis that will counteract their denial.
<angiefsu> How do you do that? Gently provide evidence?

<AdrienneFSU> I think sometimes denial is also a protective mechanism... dealing with a
          piece at a time rather than the whole thing sometimes works.
<Lisa_Scott_Trautman> Yes Adrienne, it is protective. It's a coping strategy

<Lisa_Scott_Trautman> I will also use lots of "I" statments, and "It's my observation that..."
          Because even if they don't agree, it's hard to tell someone they're wrong when
          they're offering their percpetion.
<angiefsu> I see
<Lisa_Scott_Trautman> Gentle evidence can be lots of things.
<Lisa_Scott_Trautman> "Just now, I heard you mention that... I was wondering if that's
          something you've noticed before."
<Lisa_Scott_Trautman> It can also be documentation.
<Lisa_Scott_Trautman> It can be, "it's my observation that.."
<Lisa_Geng> As a parent -hearing a diagnosis about your child at times you are in too much
          shock to believe it's not just going to go away.
<Lisa_Scott_Trautman> Lisa, good point about the shock factor.
<Lisa_Scott_Trautman> When we give news to someone, we have to remember that it's news to
<Lisa_Scott_Trautman> It may be no big deal for me to see a child with stuttering I
          consider to be mild but to that family, it might be the biggest deal they've had
          to face.
<Christine> I also find mentioning the advantages of early intervention (EI) help.
<Lisa_Geng> I agree about bringing up EI too -it's a soft way to break the news. It won't
          hurt and if your child starts talking right -then great.
<Lisa_Scott_Trautman> And if you yip on and on about what you know about stuttering, or
          apraxia or whatever, most of the time the parent doesn't really hear that.
<Lisa_Scott_Trautman> And then when you bring it up again later, they feel alarmed because
          they don't really remember, and you feel frustrated because you've already talked
          about it.
<Lisa_Scott_Trautman> Bringing up early intervention is a way to help parents "bind anxiety"
<angiefsu> Can you avoid some of that by providing information (a packet of parent info)...
          giving them something tangible to digest?
<Lisa_Scott_Trautman> Yes
<Lisa_Scott_Trautman> I always ask parents or clients when I've finished going over the
          eval with them, "What do you need from me right now?
<Lisa_Scott_Trautman> That lets them tell me what they want to hear. Usually it's "do we
          need to start therapy" or "how do we get started?"
<Lisa_Scott_Trautman> It's hardly ever, "tell me your theory about stuttering onset," which
          is what I used to tell them about.
<AdrienneFSU> lol
<Lisa_Geng> I'd like to know that theory!
<Lisa_Scott_Trautman> Ha
<angiefsu> That's a great question for parents!
<Lisa_Scott_Trautman> It also works for spouses of adult clients or whoever.
<Christine> I have learned to ask also what the parent expects from the evaluation, overall
          impressions, suggestions, etc.
<Lisa_Scott_Trautman> Yes Christine, those are great too.
<Lisa_Scott_Trautman> Because many times when you first meet a client in a medical setting,
          they're already overwhelmed by therapists and protocols and whatever.
<Lisa_Scott_Trautman> I usually will share with the client the main points in my decision
          making, e.g., one of the things we look at is whether a family member stutters
          because we know stuttering runs in the family, etc. etc.
<Lisa_Scott_Trautman> And I usually use some sort of checklist or write the main decision
          points down on a piece of paper as we talk.
<Lisa_Scott_Trautman> Then, I will add the info I have about the client.
<Christine> Thank you.  That's helps me .  I'll try to pick just 3 points to mention, and
          not go on and on.
<Lisa_Scott_Trautman> 3 is an excellent number actually, from a learning theory perspective.
<Lisa_Scott_Trautman> Then say, "so, if these are the key pieces of info, what do you think?"
<Lisa_Scott_Trautman> And then the client/family member whatever can tell me what they're
          thinking and gives them ownership in making the decision.
<Lisa_Scott_Trautman> It gets me out of the role of "expert". If I want to partner with
          the family, I need to partner with them in deciding if there's a problem and what
          to do about it.
<Lisa_Geng> Have you found stuttering families have other communication or learning
          impairments overlapping too?
<Lisa_Scott_Trautman> Lisa, yes, stuttering runs in families.

<Robin> These are all great points....here's another situation.....what happens if you
          decide that the client has reached their maximum potential in treatment, but the
          client, parent or caregiver or disagrees?
<Lisa_Scott_Trautman> Eek, that's another hard one!
<Robin> I am thinking of all the situations I have been in as a clinician.
<Lisa_Scott_Trautman> Again, this is where evidence helps.
<Lisa_Scott_Trautman> I know, I have one kid I'm thinking of right now that is my best,
          or worst, example of this situation.
<Christine> Did you give the speil about having exhausted all your resources?
<Lisa_Geng> Is it OK to say it's a "break" which is good to do for a month or two?
<Lisa_Scott_Trautman> Yeah, I usually talk about something like that.
<Lisa_Scott_Trautman> I also try to consistently deliver the message throughout therapy
          about what we're trying to accomplish.
<Lisa_Scott_Trautman> Sometimes clients or whoever just isn't ready to go where we want
          them to.
<Lisa_Scott_Trautman> If a parent or teacher is really having a heart attack about the
          possibility of dismissal, again, I go back to what is driving that -- what emotion.
<Lisa_Scott_Trautman> And it's usually about fear -- fear that it's not going to go away
           or guilt -- that nothing was done earlier.
<Robin> Those are big emotions.
<Lisa_Scott_Trautman> Sometimes they really are mad at us and think we haven't done our job,
           but I think that's less often.
<Lisa_Scott_Trautman> They are big emotions.
<Lisa_Geng> It's the stages of grief.
<Lisa_Scott_Trautman> Again, my first response in the past was to be defensive, this person
          must not think that I've done a good job.
<Lisa_Scott_Trautman> When really, that's not their primary issue.
<Christine> Do you find that sometimes happens due to the client not being able to what he
          might see as core personality traits?
<Lisa_Scott_Trautman> Yes, I do think it has to do with personality.
<Lisa_Scott_Trautman> I also think it has to do with stage of development -- some clients
          are not developmentally, either socioemotionally or cognitively, ready to move
          forward at this point in time.
<Lisa_Scott_Trautman> And, like Lisa said, sometimes it's where they're at in the grief
<Lisa_Scott_Trautman> It's important to remember that grief is not linear.
<Lisa_Scott_Trautman> Those stages of grief, denial, anger, bargaining etc. -- everyone
          moves through them in different stages
<Lisa_Scott_Trautman> And when the client makes a transition, eg. a kiddo moving from EI
          to kindergarten, for example, might trigger the grief process all over again
          because now there are new worries.
<Lisa_Scott_Trautman> Or a spouse leaving rehab for home.
<Robin> Does anyone have a specific client or situation to ask about?
<Christine> I have one.

<Lisa_Scott_Trautman> OK Christine.
<Christine> I want to know, If you have rattled on and on and you are worried one of the
          two parents are overwhelmed, is there anything you should do to help the situation?
<Lisa_Scott_Trautman> I might ask the parents to summarize what they're hearing.
<Lisa_Scott_Trautman> Just ask them what they think.
<Lisa_Scott_Trautman> Then ask the other parent, "do you have any ideas abou that?"
<Lisa_Geng> Chicken Soup for the Soul -and the story of Helen Keller are two that inspire
          most other parents I talk to that are depressed.
<Christine> No, it's been 3 days or so.
<Lisa_Scott_Trautman> you mean it's been 3 days since your meeting with the family?"
<Christine> yes
<Lisa_Scott_Trautman> I might just call them or email and ask if they have any questions.
<Lisa_Scott_Trautman> Tell them you were thinking about them and just wanted to check in
          and see how things are.
<Christine> Okay, will do
<Lisa_Scott_Trautman> I've also called a couple of families and said, "you know, I'm really
          uncomfortable with how much I blabbed the other day. I didn't give you a chance to
          ask questions or tell me what you thought." You can ask them to bring those in for
          next time.
<angiefsu> One last question, how do you keep yourself from becoming too emotionally involved?
<Lisa_Scott_Trautman> Ah, that's a very tough one.
<Lisa_Scott_Trautman> You guys ask hard questions!
<Lisa_Scott_Trautman> Usually I try to monitor my emotions when the client is telling me
<Lisa_Scott_Trautman> If I have a strong emotion, like fear or anger, or intense sadness or
          grief, it usually means there is something that is triggering something in me.
<Christine> The Dad sees the family connection (the stuttering connection), the Mom is okay
          with the condition being in the older son, her step-son, but now that her son
          presents with similar issues....
<Lisa_Scott_Trautman> Ah, that's a tough situation Christine.
<Lisa_Scott_Trautman> You really have to have an understanding of why you're doing what
          you're doing.
<Christine> Thanks, I'll take all those suggestions to heart.
<Lisa_Scott_Trautman> If your clients elicit really strong emotions, usually it means you
          are not being objective.
<Lisa_Scott_Trautman> One thing I try to tell myself is that everyone gets to where they're
          going in their own way.
<Lisa_Scott_Trautman> I can't make someone get it.
<Lisa_Scott_Trautman> Which sounds silly but it's true.
<Lisa_Geng> You can only lead to water.
<AdrienneFSU> So the question becomes... how do you stay objective?
<Lisa_Scott_Trautman> How do you stay objective? By being clear about why you're doing what
          you're doing. If you do therapy with folks because it makes YOU feel good, or gives
          YOU opportunities to show what you know, then you need to rethink.
<Lisa_Scott_Trautman> Which is not to say that we can't enjoy therapy or being good at what
          we do. But it's important to remember that we shouldn't be doing therapy to meet
          our own needs for feeling important, smart, needed, etc.
<angiefsu> good point!
<Christine> I've noted some signs of when a relationship is moving past professional
<Christine> When the parent and I start using first names, rather than the name the child
          call me "Miss Tina".
<Lisa_Scott_Trautman> Christine, how do you know? You're right, it's a feeling --
<Christine> And I usually call the parent Mom or Dad.
<Lisa_Scott_Trautman> Ah
<Lisa_Geng> Uh oh -all my kids therapists were too close to me then!
<Lisa_Scott_Trautman> Or for me if it's when I start IMing my client on a regular basis
          rather than to say, Hey, how was your speech today? I was thinking about you!
<Lisa_Scott_Trautman> ha
<Lisa_Scott_Trautman> Lisa, I think it depends on the boundaries you establish with the
          therapist. I let kids call me Lisa but that's my boundary.
<Lisa_Scott_Trautman> When you can't connect your interaction to anything related to
          therapy or the client's goals, it's probably moved away from where it should be.
<Christine> I let some call me Tina, too - But the parents usually call me Ms -Last name.
<Lisa_Scott_Trautman> I can tell a client I was thinking about them, or I'm glad to see
          them, or whatever -- that's part of letting the client know they're important to me.
<Lisa_Scott_Trautman> But if I say, I was worrying about you," then I've probably crossed
          the line.
<Lisa_Scott_Trautman> Because worry on my part is not a part of a therapeutic relationship.
<Lisa_Scott_Trautman> I don't know if that's a distinction to you all or not.
<Christine> Also, I think you might feel a dependence.  A need to share rather than it
          being motivated by the goals.
<Christine> Just like Lisa said.
<Lisa_Scott_Trautman> YES
<Lisa_Scott_Trautman> Exactly
<angiefsu> Absolutely a distinction!
<Robin> Well, this has been an enlightening chat tonight!!!
<angiefsu> Thanks Lisa
<Lisa_Geng> Thanks Lisa!
<angiefsu> I'll always think of you as I'm asking my clients "What do you need from  me!"
<Lisa_Scott_Trautman> Thanks to all of you
<ginger> A quick hi to Dr Trautman.
<Christine> Thanks and Blessings to all
<AdrienneFSU> Thanks!!
<Robin> Dr. Trautman, thank you so much for sharing your expertise with us! 
<Robin> Thank you all for coming!!!